Breast augmentation is one of the most popular cosmetic procedures performed in the United
States for the last several years. Breast Augmentation, also known as
Augmentation Mammoplasty, is a surgical procedure designed to accentuate
and enhance the size and shape of a woman`s breasts. Breast Augmentation
is beneficial for those patients who have lost breast volume due to pregnancy,
nursing or weight loss; or simply for patients with small breasts who
would like to have a fuller profile. Breast Augmentation, when performed
for an appropriate candidate with a right size and correctly positioned
implant, provide a natural look and help women with self-esteem improvement.
Breast Augmentation, by itself, will make the breasts larger, but it will
not lift or change the position of the breasts. It usually suffices on
its own, but sometimes mastopexy, otherwise known as breast lifting or
repositioning, may be required in addition to implant placement for the
best possible result. This procedure is custom tailored for each individual
patient’s needs. Dr. Rayham will be happy to address your specific
concerns and provide you with detailed information to help choose specific
approach to your breast augmentation procedure.

To improve breast symmetry for patients with unequal sized breasts due
to congenital condition or prior surgical intervention.

To improve self-esteem.

Q: How is Breast Augmentation Performed?

Dr. Rayham performs Breast Augmentation procedures in the hospital or ambulatory
surgery settings in Manhattan/NYC, Brooklyn or Staten Island, New York.
It is usually an outpatient procedure that generally lasts from one to
three hours with the patient under a general anesthesia and asleep. You
will go home the day of the operation.

Q: What’s my Incision Placement?

There are four conventional ways for
breast implant placement. Dr. Rayham in his practices in Manhattan/NYC, Brooklyn and
Staten Island, New York, offers his patients all four approaches, including
Standard Incision Breast Augmentation, Peri-Areolar Incision Breast Augmentation,
TUBA (Trans Umbilical Breast Augmentation), and Trans-Axilary Breast Augmentation.

Standard Incision Breast Augmentation – This approach utilizes the natural crease under the breast to
place a small incision through which the implant will be placed. The length
of incision is about one to one and a half inches long for saline implants
and about two inches long for silicone gel implants. This infra-mammary
incision allows the most straight forward approach to the tissues under
the breast for most accurate implant placement. The incision usually heals
well and scar gradually fades away and becomes barely noticeable.

Peri-Areolar Incision Breast Augmentation – This approach uses the advantage of color interchange between
the darker skin of nipple-areolar complex and lighter area of the surrounding
skin. An incision is made at the junction between the two types of skin
around part of the areola and nipple. The length of the incision is also
about one to one and a half inches for saline and about two inches for
silicone gel implants. As healing occurs the incision blends in and becomes
barely noticeable.

TUBA (Trans Umbilical Breast Augmentation) – This approach is used to place an incision away from the breast
and at the level of the belly button. The main advantage of this approach
is absence of visible incisions on the breast. A small semicircular incision
is usually created at the upper edge of the belly button and saline implants
placed through this incision. This is a nice way to enhance the breasts
with minimal evidence of surgery being ever done.

Trans-Axilary Breast Augmentation - This approach is also used to place an incision away from the breast.
It utilizes skin fold in the armpit area to place your incision. The length
of the incision is about one inch. Saline breast implants are placed through
those incisions. The scar usually heals well with no immediately visible
evidence of operation ever being done present in the breast area.

Dr. Rayham offers his patients all four approaches to breast augmentation
and he will be happy to discuss with you the pros and cons of each approach
for your particular procedure.

The decision of what approach will be utilized to perform your procedure
and whether or not you are a good candidate for the operation of your
choice will be dependent upon the complexity of the problem that needs
to be addressed. Dr. Rayham will be happy to discuss with you all possible
options, including implant size, texture, type, position and incision
placement, and the best approach to reach your goals.

Q: Silicone-Gels or Saline (Salt-Water) Implants?

Currently both,
Silicone Gel filled and
Saline (Salt-Water), implants are being offered in the United States for cosmetic
breast augmentation purposes. The new generation silicone implants, unlike
older types, have “gummy bear” consistency, minimizing potential
for leakage even if they are cut open. The choice of the implant will
be determined by you and Dr. Rayham during your consultation at our offices
in Manhattan/NYC, Brooklyn or Staten Island, New York. Both, silicone
gel filled and saline implants, can be placed over and under the muscle.
Usually only saline implants can be placed utilizing TUBA (
Trans Umbilical Breast Augmentation) or
Trans-Axilary Breast Augmentation techniques. Both silicone gel and saline implants can be placed through
the infra-mammary or peri-areolar incisions utilizing
Standard Incision Breast Augmentation or Peri-Areolar Incision Breast Augmentation techniques. Although not an absolute rule, patients with silicone gel
implants report more natural feel to their breasts than patients with
saline implants. The difference is especially noticeable in patients who
have very little of own breast tissue. Dr. Rayham will be happy to address
all of your questions regarding the differences between the two types
of implants and how it should reflect your body and breast shape specifically.

Q: Under the Muscle or Over the Muscle?

The choice of the
implant placement level, under the muscle (sub-muscular) or over the muscle (sub-glandular),
is dependent in large on your breast anatomy, amount of breast native
tissue, presence of so called tubular breast deformity, type and texture
of the implants, and the approach used for your breast augmentation. Specifically,
women with a limited amount of native breast parenchyma should have their
implants placed under the muscle to prevent them from being noticeable
and palpable. Patients who receive smooth textured implants should have
them placed under the muscle to minimize chances of capsular contraction
(hardening of the breast.) Women heavily involved in sports and professional
body builders should avoid having their implants placed under the muscle,
as this will make the implants visible during muscle contraction. There
are additional factors affecting the choice of the level of implant pocket
placement, and Dr. Rayham will be happy to discuss them with you during
your visit with him.

Q: Textured or Smooth Implants?

The choice of
textured or smooth implants , as it was noted in the prior section, is mainly dependent on the choice
of the pocket for implant placement. Specifically, smooth implants should
not be placed over the muscle, in the sub-glandular position, to minimize
the chances of capsular contracture. Textured implants can be placed in
either position.

Q: Are Breast Implants Safe?

In 2006, after extensive study of thousands of patients, FDA has approved
the use of
silicone-filled gel implants for cosmetic purposes. Silicone-filled gel implants have been used for
years for breast reconstruction patients without any evidence of side
effects. The saline-filled implants have also been on the market for many
years without any signs of harm to the patients. The American Society
of Plastic Surgeons (ASPS) offers a website with additional information
about safety of both saline and silicone breast implants. We encourage
you to visit
www.breastimplantsafety.org or the
FDA s website and further evaluate objective and science-based information and the guidelines
set by the FDA for women who consider breast augmentation procedure. You
can also call FDA directly (800) 532-4440 and they will mail you the booklet
with pertinent information on breast implant safety.

Q: What Should I Anticipate After the Procedure?

Your
procedure will usually last for about an hour, and sometimes up to three hours.
Upon completion of your operation bandages or a bra will be placed to
support your breasts, stabilize the implants in a desired position and
minimize the movement of the breasts and resultant discomfort. You may
experience some pain associated with the surgery which is usually controlled
well with pain medications. Upon discharge you will have prescriptions
for pain medication that you will take as needed, and antibiotics to decrease
chances of infection. You should avoid wearing a bra with an underwire
for about six weeks, or until the healing has occurred, to prevent undue
pressure onto the incisions or healing tissues. There are usually no sutures
that need to be removed. Dr. Rayham encourages his patients to refrain
from smoking for several weeks before and after the surgery. While complications
are rare, Dr. Rayham will discuss the risks of your procedure with you
prior to proceeding with surgery. If is important to be well-informed
ahead of time. You can minimize potential problems by carefully following
the directions given to you after surgery.

If you live in New York or nearby, you can go home the day of your breast
augmentation procedure. Our out of town patients normally stay overnight
in one of our recommended hotels and can be driven home or fly home the
next day following their postoperative check-up with Dr. Rayham.

Q: Am I a Candidate for Breast Augmentation?

You may be a candidate for
breast augmentation if you have any of the above concerns and if you are in overall good health
to undergo an operation. Click
here if you’d like to email Dr. Rayham with a question or a concern.